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Objective and Importance: Chronic low back pain and radiculopathy due to spondylolisthesis and spinal instability are frequent indications for decompressive lumbar laminectomy and spinal fusion with pedicle screw fixation. This procedure frequently involves a great deal of intra-operative blood loss for the patient. The objective of this study was to determine if pre-operative administration of Amicar (Epsilon-Aminocaproic Acid) reduced blood loss among patients who underwent open decompressive lumbar laminectomy and spinal fusion surgery.Study variables: 19 randomly selected patients were consented to receive Amicar preoperatively. Their intraoperative estimated blood loss as well as the Jackson-Pratt drain output were analyzed and compared to a matched group of retrospectively selected patients from our records.Technique: Data obtained from our patients were analyzed for various factors. After obtaining informed consent, patients involved in the groups were given one adult dose (5 gr IV) prior to surgery. The two groups were then compared to determine if Amicar had an effect on the EBL and other variables that might be related to blood loss.Conclusion: Although the Amicar-treated patients had lower amounts of blood loss and blood given, the differences were not significant. The non-significant differences could be due to the large observed variability for EBL and blood given in both groups and the small sample sizes for the two groups.

BackgroundRA and type 2 diabetes (T2D) have common core pathophysiologic pathways, such as insulin resistance and increased glycated end products related to endothelial dysfunction, which may portendcardiovascular disease.1 Currently there is limited real-world evidence of T2D prevalence among patients (pts) with RA.Objectives:To estimate the prevalence of T2D and insulin resistance among pts with RA vs control (osteoarthritis [OA] pts). To evaluate characteristics among RA pts with/without T2D.Methods:A retrospective study was conducted ona subset of the JointMan database (an electronic medical record of >6000 ptsfrom >10 providers. At each visit, diagnosis, medications, test results,co-morbidities and demographic data were collected. Pts aged ≥18 years with ≥2 diagnoses of RA or satisfying ACR criteria from 1 Jan 2009 to 30 Nov 2017 were included with a control group (pts with ≥2 OA diagnoses in the same period). Pts were considered to have T2D if they had a diagnosis code, diabetic medications prescription, HbA1c ≥6.5%, random glucose test ≥200 mg/dL or prior report ofT2D. Between-group prevalence was compared using a chi-squared test and characteristics of pts with/without T2D were compared using Fisher’s exact, chi-squared and Mann-Whitney tests.Results:Data were analysed from 4181, 1157 and 1626 pts in RA-only, OA-only and dual (RA plus OA) cohorts, respectively. The RA-only cohort was younger and had a lower proportion of white pts compared with other cohorts (Table). T2D prevalence was significantly higher in the dual cohort (24.3%, n=395) vs RA-only (16.2%, n=676; p<0.001) and OA-only cohorts(10.5%, n=121; p<0.001). T2D prevalence was significantly higher in the RA-only vs OA-only cohorts (p<0.001). Sicca and Sjögren's syndromes were more prevalent co-morbidities in pts with RA only with vs without T2D (16.3 vs13.0%; p=0.023) and a similar trend was observed for thyroid disorder (6.4 vs 3.7%; p=0.001).Table 1Pt Characteristics by CohortRA only (n=4181)OA only (n=1157)Dual (RA plus OA) (n=1626) With T2D (n=676)No T2D (n=3505)With T2D (n=121)No T2D (n=1036)With T2D (n=395)No T2D (n=1231) Age (years), mean (SD) 59.6 (13.5)59.6 (14.8)68.6 (9.8)65.4 (11.4)64.7 (10.5)64.5 (11.1)Female, n (%) 504 (74.6)2643 (75.4)83 (68.8)761 (73.5)294 (74.4)943 (76.6)Race, n (%) American Indian or Alaska Native29 (4.3)71 (2.0)6 (5.0)9 (0.9)12 (3.0)27 (2.2)White521 (77.1)2579 (73.6)105 (86.8)921 (88.9)363 (91.9)1127 (91.6)Co-morbidities, n (%) Sicca/Sjögren's syndromes110 (16.3)456 (13.0)20 (16.5)117 (11.3)92 (23.3)356 (28.9)Thyroid disorders43 (6.4)128 (3.7)3 (2.5)65 (6.3)27 (6.8)68 (5.5)Charlson Comorbidity Index, mean (SD) 1.02 (0.15)1.01 (0.18)1.05 (0.34)1.01 (0.12)1.01 (0.14)1 (0.09)Conclusions:A higher prevalence of T2D was observed in pts with RA compared with controls. In addition, co-morbidities of Sjögren's syndrome and thyroid disorder were higher in T2D pts with RA but not for dual RA plus OA.Reference:1. de Groot L, et al. Arthritis Res Ther 2011;13:R205.Disclosure of Interest:E. AlemaoShareholder of: Bristol-Myers...